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Pediatrics

Allocating Resources Across the Life Span During COVID-19—Integrating Neonates and Children Into Crisis Standards of Care Protocols

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Pediatrics

Published Online: December 14, 2020

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Article Information and Disclosures

Monica E. Lemmon, MD^1,2;

Robert D. Truog, MD^3,4;

Peter A. Ubel, MD^5,6

Author Affiliations

¹Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
²Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
³Center for Bioethics, Harvard Medical School, Boston, Massachusetts
⁴Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
⁵Sanford School of Public Policy, Duke University, Durham, North Carolina
⁶Fuqua School of Business, Duke University, Durham, North Carolina

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Pandemics rarely affect all age groups equally. Historically, pandemic influenzas have disproportionately impacted children. Coronavirus disease 2019 (COVID-19) primarily threatens adult populations. Yet in many hospitals, critical care resources are shared between adult and pediatric patients. Most ventilators can be used to treat both adults and children. Other resources—including medications, physical space, and staff—can be shared too.

Most protocols for resource allocation in the setting of scarce critical care resources urge hospitals to enact policies that apply to all patients in need of critical care resources—for example, a patient with a congestive heart failure exacerbation should compete for the same resources as a patient with respiratory failure related to COVID-19. According to this framework, critically ill neonates and children, regardless of COVID-19 status, must be accounted for in hospital resource allocation protocols.

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Article Information

Corresponding Author: Monica E. Lemmon, MD, Department of Pediatrics, Duke University School of Medicine, DUMC 3936, Durham, NC 27710 (monica.lemmon@duke.edu).

Published Online: December 14, 2020. doi:10.1001/jamapediatrics.2020.5215

Conflict of Interest Disclosures: Dr Lemmon reported receiving salary support from the National Institute of Neurological Disorders and Stroke and compensation for medicolegal work. Dr Truog reported receiving compensation as a consultant on data safety monitoring boards for Sanofi and Covance. No other disclosures were reported.

Additional Contributions: We thank David A. Turner, MD (Duke University), for his thoughtful review and input on this manuscript. He received no financial compensation for his contribution.

References

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White DB . A model hospital policy for allocating scarce critical care resources. University of Pittsburgh School of Medicine. Published April 15, 2020. Accessed May 22, 2020. https://ccm.pitt.edu/?q=content/model-hospital-policy-allocating-scarce-critical-care-resources-available-online-now

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.